Growing or connecting? An urban food garden in Johannesburg.

Issues of food security are of particular importance in urban areas in Africa and government policy advises on the household growing of vegetables for nutrition. The Siyakhana project is a food garden in the centre of Johannesburg which was established by a University Health Promotion Unit with the support of other stakeholders including the City authorities and a permaculture organization. It was set up with the objective of providing food for children attending early-childhood development centres and for the beneficiaries of non-governmental organizations providing home-based care for people living with HIV/AIDS. One year after start-up, an evaluation was conducted, based on the measures of outcome identified as significant by those involved in the project. Its impact on health is not yet measurable, but as the amounts of fruits and vegetables available and consumed in South Africa are low compared with WHO recommendations, it is a useful addition to food security in an urban area. Mobilizing around the food garden supported bonding among homogenous but separate third-sector organizations, through increased opportunities for networking which built trust, reciprocity and resource exchange. The project also provides a model for a community-university partnership providing opportunities for service learning by students and for social investment by the university.

The effect of deprivation, age and sex on NHS Direct call rates.

BACKGROUND: The use of primary care services in the UK is traditionally high in deprived areas. There has been little research into the effect of deprivation on the uptake of NHS Direct, a national nurse-led health helpline. AIM: To explore the impact of deprivation, age and sex on call rates to two NHS Direct sites. DESIGN OF STUDY: Ecological study. SETTING: West Yorkshire and West Midlands NHS Direct sites. METHOD: Details of NHS Direct calls between July 2001 and January 2002 were linked to electoral wards and the Indices of Multiple Deprivation for 2000. Age-standardised call rates were calculated for five deprivation levels. Using a negative binomial regression model, West Yorkshire call rates were analysed by age group, sex, deprivation level and geographical location. Rates were mapped by ward for West Yorkshire NHS Direct. RESULTS: Six-monthly call rates were highest for children under 5 years of age (130 per 1000 population). The ratio of female to male calls (all ages) was 1.30 (95% confidence interval [CI] = 1.27 to 1.33), this ratio being highest for the 15-44 year age group (P < 0.001). For both West Yorkshire and West Midlands NHS Direct, call rates (all ages combined) were highest in areas within the middle of the range of deprivation. West Yorkshire call rates about those under 5 years of age were lower in the most deprived areas than in the least deprived areas (< 1 year, P = 0.06; 1-4 years, P = 0.03). For adults aged 15-64 years, call rates were significantly higher in the most deprived areas (P < 0.001). CONCLUSION: This work supports previous research and shows that overall demand for NHS Direct is highest in areas where deprivation is at or just above the national average. Additionally, this study suggests that the effect of extreme deprivation appears to raise adult call rates but reduce rates of calls about children.

NHS Direct derived data: an exciting new opportunity or an epidemiological headache?

NHS Direct, a national telephone helpline for health advice, was established in 1998 to provide health information and advice to callers and refer them to an appropriate service. This article briefly describes the nature of the NHS Direct call record and discusses issues relevant to the use of the data for disease surveillance and epidemiological purposes. Clinical decision support software [the NHS Clinical Assessment System (NHS CAS)] is used by NHS Direct to collect callers' demographic details and direct them to the appropriate level of care. Data relating to NHS Direct calls provide a timely snapshot of symptoms occurring in the community and are summarized in 'off the shelf' NHS CAS reports. Adapting the system to provide customized data extracts requires considerable development work. When interpreting NHS Direct derived data, particular attention should be given to the age distribution of callers, NHS Direct demand surges, call 'networking' and changes to the NHS CAS clinical algorithms. An increasingly rich source of baseline data, growing body of published work, and a more 'bedded down' NHS Direct service will further our understanding and acceptance of the value of the NHS Direct call record.

Early warning and NHS Direct: a role in community surveillance?

BACKGROUND: NHS Direct is a nurse-led telephone help line that covers the whole of England and Wales. NHS Direct derived data are being used for community surveillance, the purpose of which is to detect a local or national increase in symptoms reported by callers. The system has the potential to identify an increase in symptoms reported by callers about people in the prodromal stages of illness caused by the deliberate release of a biological or chemical agent. There are no other community surveillance projects existing on a national scale that utilize electronic daily data. METHODS: We describe the surveillance system and calls to NHS Direct between December 2001 and July 2002. Confidence limits have been constructed for 10 key algorithms at each site and control charts devised for five of these algorithms at sites covering the key urban areas. RESULTS: Daily reporting has been achieved from NHS Direct sites in England and Wales. High levels of activity in specific algorithms at both national and regional levels have been detected. A sustained national increase in calls about fever occurred in January 2002. CONCLUSION: Although the project is still at an early stage, daily analysis of NHS Direct data has the potential to detect symptoms in the community that could be related to deliberate releases of chemical or biological agents or to outbreaks of disease. For this surveillance to act as an 'early warning' of illness resulting from a microbiological or chemical cause, the NHS Direct surveillance needs to be fully integrated into an appropriate public health response (which may require diagnostic samples to be taken from callers).